scholarly journals TRAUMATIC CERVICAL SPINAL CORD INJURY. IS URGENT INTERVENTION SUPERIOR TO DELAYED INTERVENTION? A META-ANALYSIS EVALUATION

2019 ◽  
Vol 8 (1) ◽  
pp. 12
Author(s):  
I Ketut Martiana ◽  
Donny Permana ◽  
Lukas Widhiyanto
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Procedure ◽  
Cervical Spinal Cord ◽  
Meta Analysis ◽  
Neurological Status ◽  
Trauma Patients ◽  
Cervical Trauma ◽  
Significant Difference ◽  
Cord Injury

Introduction: Cervical spine is the most mobile part of the human spine, thus making it the most vulnerable compared to all the other vertebral structures. Surgical procedures are usually performed within the first 24 hours, or 4-6 weeks after trauma in order to prevent any secondary trauma. The research was conducted to evaluate the amount of time of the surgical procedure towards the effectivity and improvement of the neurological status in the cervical injury or acute spinal cord injury (ASCI).Methods: A meta-analysis research which evaluate the effectivity of surgical procedure on cervical trauma/ASCI, with the database procured from PubMed, Embase, and Cochrane. The main parameter is the decompression procedure and the clinical outcome which were categorized. The time of surgery or decompression are categorized into “<24 hours” and “>24 hours”, the neurological outcome is categorized into “improvement” and “no improvement”. The data was presented in odd ratio (OR) and confidence interval (CI) and were further analyzed by forest plot.Results: From PubMed, there were 353 articles, Embase 2 articles, and Cochrane 594 articles, but only 3 articles which fulfilled the inclusion criteria. The comparison between the surgical procedure in the cervical <24 hours with the surgical procedure >24 hours was identified for this research. Statistically, there was a significant difference on the neurological status (OR=1,85; 95%CI=1,21-2,84; p<0,01).Conclusion: With meta-analysis background, early decompressive procedure <24 hours for cervical trauma patients produced a significantly better result in improving the neurological status compared to the late decompressive procedure >24 hours.

scholarly journals The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze Lin ◽  
Yun Sun ◽  
Hang Xue ◽  
Lang Chen ◽  
Chenchen Yan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Venous Thrombosis ◽  
Meta Analysis ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Cord Injury ◽  
Review Manager ◽  
Evident Difference

Abstract Background Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Materials and methods Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3. Results A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42–4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55–1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found. Conclusions The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.

scholarly journals Surgical airway procedures in emergency surgical patients: Results of what has become a back-up procedure

2021 ◽  
Author(s):  
Gijs J. A. Willinge ◽  
Falco Hietbrink ◽  
Luke P. H. Leenen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Outcomes ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Surgical Patients ◽  
Trauma Patients ◽  
Airway Patency ◽  
Surgical Tracheostomy ◽  
Cord Injury

Abstract Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.

scholarly journals A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Yan Wang ◽  
Zhiliang Guo ◽  
Dehong Fan ◽  
Haijiang Lu ◽  
Dong Xie ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Influencing Factors ◽  
Cervical Spinal Cord ◽  
Meta Analysis ◽  
Cervical Spinal Cord Injury ◽  
Thoracic Injury ◽  
Current Evidence ◽  
Respiratory Complications ◽  
Cord Injury

Background. Traumatic cervical spinal cord injury (CSCI) is a common disease that has high complication, disability, and mortality rates and a poor prognosis. Tracheostomy is an important supportive therapy for patients with CSCI. However, a consensus on the predictive factors for tracheostomy after CSCI has not been reached. Objective. This meta-analysis study assessed the influencing factors for tracheostomy after CSCI. Methods. We searched for relevant studies on the influencing factors for tracheostomy after CSCI. The extracted data were analyzed using RevMan 5.3 software. We calculated the odds ratio (OR) or mean difference (MD) and 95% confidence intervals (CIs). Results. Sixteen eligible studies containing 9697 patients with CSCI were selected. The pooled OR (MD) and 95% CI of the influencing factors were as follows: age (mean ± SD): -0.98 (-4.00 to 2.03), advanced age: 1.93 (0.80 to 4.63), sex (male): 1.29 (1.12 to 1.49), American Spinal Injury Association Impairment Scale (AIS) A grade: 7.79 (5.28 to 11.50), AIS B grade: 1.15 (1.13 to 2.02), AIS C grade: 0.28 (0.20 to 0.41), AIS D grade: 0.04 (0.02 to 0.09), neurological level of injury (upper CSCI): 2.36 (1.51 to 3.68), injury severity score (ISS): 8.97 (8.11 to 9.82), Glasgow Coma Scale (GCS) score ≤8: 6.03 (2.19 to 16.61), thoracic injury: 1.78 (1.55 to 2.04), brain injury: 0.96 (0.55 to 1.69), respiratory complications: 5.97 (4.03 to 8.86), smoking history: 1.45 (0.99 to 2.13), traffic accident injury: 1.27 (0.92 to 1.74), and fall injury: 0.72 (0.52 to 1.01). Conclusions. The current evidence shows that male sex, AIS A grade, AIS B grade, neurological level of injury (upper CSCI), high ISS, GCS≤8, thoracic injury, and respiratory complications are risk factors for tracheostomy after CSCI, and AIS C grade and AIS D grade are protective factors. This study will allow us to use these factors for tracheostomy decisions and ultimately optimize airway management in patients with CSCI.

Trauma

2020 ◽  
pp. 131-170
Keyword(s):  
Traumatic Brain Injury ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Cervical Spinal Cord ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Cord Injury

This chapter discusses traumatic spinal cord and brain injuries. The first three studies review the background and key findings of the third National Acute Spinal Cord Injury Study (NASCIS) trial, examine the efficacy of the Canadian C-Spine Rule in the evaluation of cervical spine injuries in alert and stable trauma patients; and describe the development of the Thoracolumbar Injury Classification and Severity Score (TLICS) classification system. The next two studies assess the effect of early surgical decompression in patients with traumatic cervical spinal cord injury and delineate the role of secondary brain injury in determining patient outcome in severe traumatic brain injury. The following set of four studies evaluates the efficacy of phenytoin in preventing posttraumatic seizures, as well as the efficacy of intracranial pressure monitoring, induction of hypothermia, and decompressive craniectomy for severe traumatic brain injury. The last study, which is of historical value, identifies predictors of outcome in comatose patients with traumatic acute subdural hematoma.

Acute cervical spinal cord injury and extubation failure: A systematic review and meta-analysis

2020 ◽  
Vol 33 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Miles Wilson ◽  
Marc Nickels ◽  
Brooke Wadsworth ◽  
Peter Kruger ◽  
Adam Semciw
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Meta Analysis ◽  
Extubation Failure ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

scholarly journals Surgical management of penetrating spinal cord injury primarily due to shrapnel and its effect on neurological outcome: a literature review and meta-analysis

2018 ◽  
Vol 28 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Michael H. Lawless ◽  
Evan J. Lytle ◽  
Andrea F. McGlynn ◽  
John A. Engler
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Neurological Recovery ◽  
Forest Plot ◽  
Odds Ratios ◽  
Significant Difference ◽  
Cord Injury

OBJECTIVEThis study was performed to determine whether decompression of penetrating spinal cord injury (SCI) due to explosive shrapnel leads to greater neurological recovery than conservative management.METHODSIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search using PubMed/MEDLINE, Web of Science, Google Scholar, and the Defense Technical Information Center public site was conducted on May 2, 2016. Studies that described penetrating SCI with shrapnel as an etiology, included surgical and/or conservative management, and demonstrated admission and follow-up neurological status were eligible for inclusion in this study. Odds ratios were calculated for the overall effect of surgical treatment on neurological recovery. Funnel plots were used to evaluate publication bias.RESULTSFive case series (Level IV evidence) met the study criteria, and 2 of them had estimable odds ratios for use in the Forest plot analysis. Among the patients from all 5 studies, 65% were injured by shrapnel, 25% by high-velocity bullet, 8% by low-velocity bullet, and 2% by an unknown cause. A total of 288 patients were included in the overall odds ratio calculations. Patients were stratified by complete and incomplete SCI. The meta-analysis showed no significant difference in outcomes between surgical and conservative management in the complete SCI cohort or the incomplete SCI cohort. Overall rates of improvement for complete SCI were 25% with surgery and 27% with conservative treatment (OR 1.07, 95% CI 0.44–2.61, p = 0.88); for incomplete SCI, 70% with surgery and 81% with conservative treatment (OR 1.67, 95% CI 0.68–4.05, p = 0.26).CONCLUSIONSThis study demonstrates no clear benefit to surgical decompression of penetrating SCI due predominantly to shrapnel. There is a considerable need for nonrandomized prospective cohort studies examining decompression and stabilization surgery for secondary and tertiary blast injuries.

A comparison of prefabricated and custom made resting hand splints for individuals with cervical spinal cord injury: A randomized controlled trial

2020 ◽  
pp. 026921552098348
Author(s):  
Sara Kate Frye ◽  
Paula Richley Geigle
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Structured Interview ◽  
Cervical Spinal Cord Injury ◽  
User Preference ◽  
Randomized Controlled ◽  
Custom Made ◽  
Significant Difference ◽  
Cord Injury

Objective: To compare prefabricated and custom resting hand splints and establish the feasibility of splinting research for larger scale trials. Design: A Randomized controlled pilot study where the randomization unit was each hand, rather than each individual. Setting: Thirty-two-bed spinal cord injury and multi-trauma rehabilitation unit in an urban academic rehabilitation center. Subjects: Thirty-six hands from 19 individuals with cervical spinal cord injury were enrolled during their acute rehabilitation stay. Interventions: Each eligible hand was randomized to receive a custom or prefabricated resting hand splint for night use. Main measures: The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) was completed at both admission and discharge, and a structured interview was completed at discharge. Results: No difference existed in GRASSP outcomes or user preference between custom and prefabricated resting hand splints. Mann-Whitney tests indicated that there was no significant difference in qualitative prehension scores (U = 141, P = 0.522) nor quantitative prehension scores (U = 135, P = 0.382) between groups. Adherence to the splinting program was high (18 out of 19 participants), and no adverse effects occurred. Four themes emerged from the participant comments: the participants felt splints were helpful in their recovery; they found it challenging to direct their caregivers to help with the splints; they needed to take ownership for managing their splints; and they wished they received more education on splint rationale. Conclusion: There was no obvious difference in outcome or user preference between prefabricated and custom resting hand splints.

scholarly journals A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury

2017 ◽  
Vol 43 (1) ◽  
pp. E6 ◽  
Author(s):  
Ross M. Mandeville ◽  
Justin M. Brown ◽  
Geoffrey L. Sheean
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Nerve Transfer ◽  
Neurological Status ◽  
Cervical Spinal Cord Injury ◽  
Upper Limb Function ◽  
Potential Efficacy ◽  
Cord Injury ◽  
Pertinent Information

A successful nerve transfer surgery can provide a wealth of benefits to a patient with cervical spinal cord injury. The process of surgical decision making ideally uses all pertinent information to produce the best functional outcome. Reliance on clinical examination and imaging studies alone can miss valuable information on the state of spinal cord health. In this regard, neurophysiological evaluation has the potential to effectively gauge the neurological status of even select pools of anterior horn cells and their axons to small nerve branches in question to determine the potential efficacy of their use in a transfer. If available preoperatively, knowledge gained from such an evaluation could significantly alter the reconstructive surgical plan and avoid poor results. The authors describe their institution’s approach to the assessment of patients with cervical spinal cord injury who are being considered for nerve transfer surgery in both the acute and chronic setting and broadly review the neurophysiological techniques used.

Sign in / Sign up

Export Citation Format

Share Document